The use of selective serotonin receptor inhibitors (<scp>SSRI</scp>s) is not associated with increased risk of endoscopy‐refractory bleeding, rebleeding or mortality in peptic ulcer bleeding

Laursen, Stig Borbjerg; Leontiadis, Grigorios I; Stanley, Adrian J.; Hallas, Jesper; Muckadell, Ove B. Schaffalitzky de

doi:10.1111/apt.14153

Cited by 12 publications

(21 citation statements)

References 22 publications

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“…Evidence for blood transfusion (one study [ 54 ]), endoscopy-refractory bleeding (one study [ 55 ]), and rebleeding (one study [ 55 ]) are inconclusive owing to the limited data available ( Supplementary, eTable 8 ). However, no study has reported bleeding complications in terms of bleeding related to mortality.…”

Section: Resultsmentioning

confidence: 99%

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

et al. 2021

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Background Serotonin reuptake inhibitor (SRI) antidepressants are implicated in increasing the risk of bleeding among users; however, the comparative increase in bleeding risk with concurrent antithrombotic therapy (anticoagulant or antiplatelet) remains unclear. As such, we performed a systematic review and meta-analysis of all available evidence to evaluate the effects of SRI and the risk of bleeding complications among patients receiving antithrombotic therapy. Methods We searched Medline, Embase, PubMed, PsycINFO, Cochrane Library, Web of Science, Scopus, CINAHL, and grey literature (Google Scholar and preprint reports) up to 26 November, 2020, with no language restrictions (updated on 31 July 2021). The primary outcome of interest was major bleeding. Secondary outcomes included intracranial haemorrhage, gastrointestinal bleeding, and any bleeding events. We used a random-effects model meta-analysis to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results We did not identify any randomised studies but found 32 non-randomized studies (cohort or case–control) with 1,848,285 patients that fulfilled the study selection criteria and were included in the meta-analysis. Among individuals receiving anticoagulants (13 studies), SRI users experienced a statistically higher risk of major bleeding compared to non-SRI users: pooled OR was 1.39 (95% CI, 1.23–1.58; p < .001; moderate heterogeneity). Among individuals receiving antiplatelet therapy (2 studies), SRI users were associated with an increased risk of major bleeding: pooled OR was 1.45 (95% CI, 1.17–1.80; p = .001; low heterogeneity). For secondary outcomes, the use of SRI among individuals treated with antithrombotic therapy revealed a higher risk of gastrointestinal bleeding or any bleeding events, whereas only anticoagulant use was illustrated an increased risk of intracranial haemorrhage. Conclusions The use of SRI antidepressants among patients treated with antithrombotic therapy (either anticoagulant or antiplatelet) is associated with a higher risk of bleeding complications, suggesting that caution is warranted in co-prescription. PROSPERO Registration CRD42018083917 KEY MESSAGES In this meta-analysis of 32 non-randomized studies, SRI users were associated with the risk of bleeding complications compared to non-SRI users, with concurrent antithrombotic use (either anticoagulant or antiplatelet). The risk was consistently elevated across types of bleeding events (major bleeding, gastrointestinal bleeding, or any bleeding events), whereas only anticoagulant use was associated with intracranial haemorrhage. To promote the rational use of medicines, our findings suggest that the risk-benefit ratio must account for the clear efficacy of SRI against safety concern...

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Section: Resultsmentioning

confidence: 99%

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

et al. 2021

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“…The use of selective serotonin reuptake inhibitors has been associated with a modest increase in the risk of NSAID‐induced gastroduodenal bleeding . However, a recent study did not show an increased risk of bleeding in either patients with selective serotonin reuptake inhibitor intake or in patients with a combination of selective serotonin reuptake inhibitors and NSAID intake . With the exception of one Danish study showing that H. pylori infection increases the overall risk of serious upper gastrointestinal bleeding in patients using selective serotonin reuptake inhibitors with an adjusted OR of 2.73 (95% CI = 1.17‐6.36), no other data are available on this topic .…”

Section: Introductionmentioning

confidence: 99%

Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti‐inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors

Venerito

Schneider

Costanzo

et al. 2018

Aliment Pharmacol Ther

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“…In contrast, Laursen et al found that SSRI was not associated with increased risk of endoscopy‐refractory peptic ulcer bleeding. The discrepancy may be accounted by the use of different primary outcomes that endoscopy‐refractory bleeding was used in the study by Laursen et al, which is the most severe end of the bleeding spectrum.…”

Section: Discussionmentioning

confidence: 89%

Risks of hospitalization for upper gastrointestinal bleeding in users of selective serotonin reuptake inhibitors after Helicobacter pylori eradication therapy: a propensity score matching analysis

Guo

Cheung

Zhang

et al. 2019

Aliment Pharmacol Ther

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Summary Background Selective serotonin reuptake inhibitors (SSRIs) are the first‐line treatment for depression but there is a concern about the risk of upper gastrointestinal bleeding (UGIB). Past studies, however, are largely confounded by the presence of Helicobacter pylori (HP). Aim To evaluate the UGIB risk of SSRI users after treatment for HP. Methods This was a propensity score (PS) matched cohort study with patients who used SSRI after receiving HP eradication therapy from the Hong Kong territory‐wide healthcare database. The primary outcome was hospitalisation for nonvariceal UGIB. PS matching analysis with a ratio of 1:2 plus Cox regression model was used to compute the hazards ratios (HR) and 95% CI of UGIB risk. Results In this study, 3358 SSRI users and 57 906 non‐users were included. The median follow‐up duration was 7.74 (interquartile range 5.32‐10.42) years. The crude incidence of hospitalisation for UGIB was 3.98 (95% CI 3.80‐4.16) per 1000 person‐years. In the PS matching analysis of 3358 SSRI users with 6716 non‐users, SSRI was associated with a higher risk of UGIB compared to non‐users (HR 1.95, 95% CI 1.41‐2.70). This result was consistent in sensitivity analysis with 1:1 PS matching (HR 2.13, 95% CI 1.50‐3.02) and multivariable analysis with 1‐month intervals (HR 1.81, 95% CI 1.34‐2.45) or 3‐month intervals (HR 1.61, 95% CI 1.20‐2.17). After stratifying by age, the increased risk of SSRI was only significant among patients >50 years. Conclusion SSRI users have a higher risk of hospitalisation for nonvariceal UGIB after treatment for HP, particularly among older patients.

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The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy‐refractory bleeding, rebleeding or mortality in peptic ulcer bleeding

Abstract: According to our data, treatment with SSRIs does not influence the risk of endoscopy-refractory bleeding, rebleeding or 30-day mortality in peptic ulcer bleeding.

Cited by 12 publications

References 22 publications

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti‐inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors

Risks of hospitalization for upper gastrointestinal bleeding in users of selective serotonin reuptake inhibitors after Helicobacter pylori eradication therapy: a propensity score matching analysis

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